Between 1979 and 1995, a total of 6615 deaths (about 390 per year) in the United States were considered to be caused by the effects of heat and excessive heat exposure.1 Because many of those who died were elderly, with underlying cardiopulmonary illnesses, there is a general acknowledgment that deaths caused by heat are underreported.2 Estimations of the number of heat-related deaths per year have been as high as 4000 in the United States. The annual rate of heat-related deaths is highest among the elderly: fewer than 1 per million in the 5- to 44-year age group and increasing to about 5 per million in the over-85-year age group. 1 The young are also at increased risk, with attack rates of 0.3 per million among those younger than age 4 versus 0.05 among those older than age 4. 1 Heat-related illness is the second leading cause of death among young athletes. For patients with heatstroke, the most severe heat-related illness syndrome, mortality rates range from 10 to 75 percent. Heat-related illness and deaths are clearly related to high environmental temperature, and increased numbers have been seen in urban heat waves in the United States and elsewhere.34 Although heat-related illness occurs in healthy individuals exposed to extremes of heat and humidity, it is especially dangerous for those impaired by chronic illness, drugs, and age.

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